How do you approach management of a patient with a VNS device that is having impedance challenges?

We always take an X-ray to ensure that there is no obvious disconnect or breakage of the lead. If not, we prepare to replace the electrode, including consent and surgical prep. If we can resolve the impedance issue by checking or tightening the connection to the IPG, then we will do so and close. If...

Device malfunction can be a long road, so a stepwise approach is necessary to avoid missing a "quick fix." First, I would contact the device rep to evaluate the system. At the same time, I would obtain cervical AP and lateral X-rays to see if there were any obvious break or disconnection. If the ini...